AB0361 TOCILIZUMAB VERSUS TOFACITINIB IN THE 12-MONTH TREATMENT OF BIOLOGICAL-NAIVE PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS
Authors: D. Gerasimova, E. Gerasimova, T. Popkova, O. Zakharova, V. Medvedeva
Journal: Annals of the Rheumatic Diseases (2022)

Background The choice of the most effective disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA) remains relevant. There are several comparative studies between tocilizumab (TCZ), an antibody against interleukin 6 receptor, and tofacitinib (TOFA), a potent selective Janus kinase inhibitor, regarding their efficacy [1,2]. Objectives To compare the effectiveness of TCZ and TOFA for treatment of biological-naive patients (pts) with active RA according to various indicators of disease activity, physical function, and quality of life during a 12-month (m) follow-up period. Methods A total of 80 biological-naive pts with high and moderate RA activity were enrolled (40 pts with TCZ and 40 pts with TOFA). The groups were comparable in terms of sex, age, BMI, and DAS28. All pts were measured: for disease activity using DAS28, SDAI, and CDAI; for quality of life and physical function using EQ-5D, HAQ, and RAPID 3 questionnaires at the beginning of the study and after 12 m of TCZ/TOFA therapy. The EULAR response criteria for treatment of RA were used. Results Significant positive changes in major disease activity, clinical and laboratory parameters were found in RA pts after 12 m of TCZ infusion and TOFA intake: DAS28, SDAI, and CDAI decreased significantly in both groups (p&lt;0.01 in all cases). There were more good responders among TCZ pts compared to TOFA pts: by DAS28 35 pts (87.5%) vs. 20 pts (50%), p&lt;0.01; by CDAI 38 pts (95%) vs. 26 pts (65.7%), p=0.02, respectively. There was a more pronounced decrease in DAS28 and CRP levels in TCZ pts (ΔDAS28=-3.8[-4.5;-2.7], ΔCRP=-26.5[-45;-10.7] mg/L) compared to TOFA pts (ΔDAS28=-2,3[-3.2;-1.5]; ΔCRP=-10.1[-32;-8] mg/L, p&lt;0.01 in all cases). Both drugs equally improved quality of life and physical function indicators EQ-5D, HAQ, and RAPID during a 12-m follow-up period. Correlations of ΔEQ-5D with ΔESR (R=0.43: p&lt;0.01) and with ΔCRB (R=0.46; p=0.03) were found after 12 m of TCZ therapy. Conclusion TCZ and TOFA both significantly reduce disease activity and improve quality of life and physical function in bDMARD-naive RA patients. Compared with TOFA, TCZ can induce greater improvements during the first 12-m treatment. No unequivocal conclusions on the drugs’ effect on pts’ quality of life could be made. References [1]Fautrel B, Zhu B, Taylor PC, van de Laar M, Emery P, De Leonardis F, Kannowski CL, Nicolay C, Kadziola Z, De La Torre I, Fleischmann R. Comparative effectiveness of improvement in pain and physical function for baricitinib versus adalimumab, tocilizumab and tofacitinib monotherapies in rheumatoid arthritis patients who are naive to treatment with biologic or conventional synthetic disease-modifying antirheumatic drugs: a matching-adjusted indirect comparison. RMD Open. 2020 Apr;6(1):e001131. doi: 10.1136/rmdopen-2019-001131; [2]Mori S, Urata Y, Yoshitama T, Ueki Y. Tofacitinib versus tocilizumab in the treatment of biological-naive or previous biological-failure patients with methotrexate-refractory active rheumatoid arthritis. RMD Open. 2021 May;7(2):e001601. doi: 10.1136/rmdopen-2021-001601. Disclosure of Interests None declared